Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Breast Augmentation by Implants

What is Breast Augmentation by means of Implants?

Breast augmentation is the enlargement and firming of the breast by the placement of a filled balloon-like pocket (prosthesis) under the breast tissue or under the chest muscles. The pocket, which is made of a thin, soft, layer of solid silicone is filled with either a silicone gel or with Normal Saline i.e. a physiological salt solution.

To place the implants in their positions, incisions are made through the skin and the spaces for the implants are created by surgical dissection.

It is possible to perform breast augmentation with the use of your own tissues instead of prostheses.

 

If you have chosen to have a breast augmentation there are certain criteria to be borne in mind.

 

Benefits

  • An improved self-image leading to greater confidence.
  • Improved clothing choices
  • A feeling of restored youth and vigour in those who have experienced loss of breast substance and consequent sagging due to pregnancy and lactation.

 

Negative aspects.

  • At present you are free of scars, after surgery scarring is inevitable. Development of scars varies from person to person. Our aim is to finally achieve mature scars that are thin, soft, pale lines which are hidden from view as well as possible. To help you in this, please refer to our page on scar care. The scars required for insertion of breast prostheses are usually placed in either the axilla (armpit), around the lower half of the areola, or under the breast near the fold (see sketches). Breast prostheses have been inserted via the navel by some surgeons, but the advantages are questionable and there are numerous associated limitations.
     
  • The prostheses which are used to enlarge your breasts, are designed and produced with great care, but they are seen by your body as foreign objects. They will never be “rejected”, but your own tissues will create a barrier around the outside of the prosthesis. The formation of this barrier or capsule is inevitable, but our aim is to do all we can to get this capsule to be as thin, soft and pliable as possible. A firm, strong and or contracted capsule can lead to increased pressure in the prosthesis which in turn makes the breast feel too firm.
     
  • Many patients experience either increased or decreased sensitivity in the nipple post surgery. In the vast majority of patients this returns to normal within six months

 

Complications

We try at all times to avoid complications by taking every precaution available to us and by employing meticulous techniques. Complications, however, will sometimes occur even in the hands of the most careful surgeon.
 

  • As with any surgical procedure the wounds may become infected which may prolong your treatment which might include drainage, dressings and antibiotics. Infection may also necessitate removal of the prosthesis. Infection may also predispose one to a greater risk of capsular contracture.
  • A bleed may occur after surgery and it may be necessary to return to the operating theatre to stop such a bleed and remove the excess blood from around the prosthesis.
  • Pain is sometimes experienced in the first few post-operative days. The pain is more severe when prostheses have been placed under the pectoral muscles. Sometimes very sharp pains of a very short duration occur. These pains are known as lightning pains and their occurrence is infrequent and disappears after a few months.
  • Capsular contracture with consequent hardening of the breast is probably the most important complication of this procedure. The textured surface designs of modern prostheses have done a lot to avert this problem. Good support of the breasts while the internal “wounds and scars” are healing will also help a lot to avoid Capsular Contracture.
  • Prostheses may sometimes rupture. If a silicone gel filled prosthesis has ruptured, you will quite possibly be unaware that it has happened. The silicone will be kept contained by the capsular wall which has been created by your own tissues. Only under exceptional conditions such as severe trauma, may your own capsule be ruptured and cause silicone gel to be extruded into the surrounding tissues. If you have a saline filled prosthesis you will soon be aware of a rupture as the saline solution will be completely absorbed by your body and the breast will lose volume. The risk of rupture increases with time and some surgeons advocate that prostheses should be replaced every 8 to 10 years.
  • Stretch marks (Striae gravidorum) might appear on your breasts due to rapid stretching of the skin.
  • Ripples or ruckles may become visible on the breast surface especially in patients who are very slim. They may then need to be treated by a further procedure consisting of Micro Fat grafting
  • The prosthesis may become palpable in some areas especially along the edges of the breast. This is because the implant is often larger than the breast tissue. The larger the implant, the greater the risk of palpability.

 

The Choices you must make

  • We strongly advise that you should use textured prostheses which have a lower propensity for capsular contracture and which also adhere to surrounding tissues so that they remain in one position and do not slip around, but if you insist on smooth prostheses we can oblige.
  • You must choose between Saline filled and Silicone Gel filled prostheses.
  • You must choose the approximate size of prosthesis you would be comfortable to use. My best advice is to choose the smallest prosthesis that would make you happy - Remember, the larger the prosthesis, the larger the risk of complications.
  • Quality of prostheses (associated with cost). There are cheaper prostheses available, but we prefer to use the best quality products that are available to us.
  • Local or General anaesthetic, remembering that local anaesthetic in this practice limits your choice of scar to a sub-mammary incision.
  • Incision site, in this practice we prefer the Peri-areolar or sub-mammary incisions, if you are having a general anaesthetic procedure, you can choose your incision. Remember too, that the peri-areolar incision has 2 drawbacks
    • Greater risk of sensory changes in the nipple
    • Greater risk of skin bacteria contaminating the prosthesis from the nipple ducts.

 

How to Prepare for the Procedure

  • Arrange a consultation with the surgeon (Make a consultation booking)
     
  • At Consultation you will find out if you are a suitable candidate for the procedure (not everyone is )
     
  • Usually, you will be able to try some implants in your bra, so it is a good idea to bring an unpadded, underwired bra of the size you would like to be. Remember, we cannot change your chest size, if you are a 32, you will stay a 32, but your cup size will be increased by the implant. So, bring a bra that fits your chest properly and has cups of the desired size. We will then be able to see how much extra volume you will need to fill that bra and also what type and size of implants would suit your needs.
     
  • Obtain a quote for the procedure so that you can plan finances.
     
  • When you are ready, schedule an operation date and pay your booking deposit
     
  • Prepare your body:
    • Keep fit
    • Stop smoking!
    • Prepare your breast skin by using a pregnancy cream such as Dermastine regularly to help prevent stretch marks
    • Stop taking anticoagulant medications such as Disprin, Aspirin, Ginko Biloba, Evening Primrose oil, Omega 3 Salmon Oil, Flaxseed Oil, Arnica and Vitamin E at least 10 days before your procedure. (If these substances have been prescribed by your doctor, then please discuss with your surgeon and the prescribing doctor whether they should be stopped) .
    • Do NOT sunburn/sunbathe your breasts pre-operatively, if your upper body shows signs of sunburn, the procedure will be postponed
    • Buy an underwired bra of the correct discussed size and another one which is one cup size larger to accommodate early swelling.
       
  • Schedule an appointment with one of our Registered Nurse Practitioner Consultants who will
    • Re-discuss the details of the procedure with you.
    • Give you an opportunity to ask questions
    • Give you a pack containing useful items for the peri-operative period.
    • Give you an appropriate prescription for post-operative medication.
    • Go through the informed consent document with you

       
  • Pay the remainder of the procedure fee at least one week before the procedure to facilitate ordering of prostheses and special materials, drapes and instruments

 

Immediate Pre-Op Checklist

  • Arrange to be transported too and from the procedure
  • Make a note of accompanying person's contact details to hand to us
  • Stay "Nil Per Mouth" for 6 hours before your scheduled procedure time
  • Shower head to toe with medicated shampoo to reduce the bacterial load on the skin
  • Wear loose clothing
  • Pack your Bras
  • Give yourself enough time for a relaxed approach.

 

Post-Operative Care

  • Wear your Underwired Bra day and night for one month - This keeps your prostheses stable and well positioned during the critical early healing period
  • You may be asked to wear an elastic "Care-Fix" strap over your bra to add further stability
  • Waterproof dressings will allow you to shower from day 1. Bathing and swimming allowed only after 7 days
  • Attend your "dressing change" consultation with the Registered Nurse Practitioner and pay careful attention to the "scar taping" instructions that you will be given.
  • Tape your scars correctly for 4 to 6 months ("if we support the scars, they will not need to support themselves" and they will therefore remain as thin flat lines rather than becoming ridges)
  • After 1 month, you can stop wearing the bra at night, but you must continue to wear it every day when you are up and about.
  • When exercising, wear a Sports Bra such as a "Triumph Shock Absorber " over your underwired bra.Good support of the healing internal "scars" is vital.
  • Enjoy your new appearance with confidence.